Chirico Claudio, Giorgianni Andrea, Clivio Veronica, Malnati Silvia, Gatta Tonia, Vizzari Francesco Alberto, Pellegrino Carlo, Fusco Massimo, Piacentino Filippo, Venturini Massimo, Fontana Federico
Diagnostic and Interventional Neuroradiology Unit, Circolo Hospital, ASST SetteLaghi, 21100, Varese, Italy.
Department of Medicine and Technological Innovation, Insubria University, 21100, Varese, Italy.
J Med Case Rep. 2025 May 1;19(1):202. doi: 10.1186/s13256-024-04989-z.
Takayasu arteritis is a rare form of large-vessel vasculitis primarily affecting the aorta and its major branches, with a higher prevalence in young women. This inflammatory disease can lead to significant complications, including ischemic stroke and transient ischemic attacks, though large-vessel occlusion stroke is an uncommon initial manifestation. Diagnosis relies heavily on vascular imaging, and treatment typically involves high-dose glucocorticoids, revascularization procedures, and close monitoring for restenosis, which occurs frequently after interventions.
This case report describes a 38-year-old North African woman who presented with acute left-sided hemiparesis and visual disturbances due to large-vessel occlusion involving the common carotid artery and middle cerebral artery. Mechanical thrombectomy and stenting were performed successfully, resulting in complete recanalization without complications. The patient was later diagnosed with Takayasu arteritis, and this was managed with high-dose corticosteroids. During a 2-year follow-up, no complications such as restenosis or re-occlusion were observed, and the patient remained in good health.
This case is notable for the successful use of dual mechanical thrombectomy and stenting in the acute management of stroke in Takayasu arteritis without short- or long-term complications, a rare outcome not commonly reported in the literature. It highlights the potential efficacy of this approach in carefully selected patients, suggesting that postoperative immunosuppressive therapy may reduce the incidence of restenosis.
大动脉炎是一种罕见的大血管血管炎，主要累及主动脉及其主要分支，在年轻女性中患病率较高。这种炎症性疾病可导致严重并发症，包括缺血性卒中和短暂性脑缺血发作，尽管大血管闭塞性卒中是一种不常见的初始表现。诊断主要依靠血管成像，治疗通常包括大剂量糖皮质激素、血管重建手术以及对再狭窄进行密切监测，再狭窄在干预后经常发生。
本病例报告描述了一名38岁的北非女性，因涉及颈总动脉和大脑中动脉的大血管闭塞而出现急性左侧偏瘫和视觉障碍。成功进行了机械取栓和支架置入术，实现了完全再通且无并发症。该患者后来被诊断为大动脉炎，并接受了大剂量皮质类固醇治疗。在2年的随访中，未观察到再狭窄或再闭塞等并发症，患者保持健康。
本病例因在大动脉炎所致卒中的急性治疗中成功使用双重机械取栓和支架置入术且无短期或长期并发症而值得关注，这是文献中较少报道的罕见结果。它突出了这种方法在精心挑选的患者中的潜在疗效，表明术后免疫抑制治疗可能降低再狭窄的发生率。
